Thursday, October 16, 2014

Ebola pandemic 2014 @ Week 41

Copyright  Françoise Herrmann

**Maybe, it’s time to start thinking about evacuating those people still healthy and willing to leave from the uncontrolled Ebola infected areas, in Sierra Leone, Liberia and  Guinea. I know this is what I would like rescue efforts to do for me and my family, if  it were our situation.. 

 On August 20th, 2014, I posted figures of the death toll from the Ebola virus culled from the WHO (World Health Organization) website. There were a total of 1267 reported deaths and 2617 cases reported.

Today, October 16, 2014 (almost two months later), WHO reports 4493 deaths and a total of total of 8897 confirmed, probable and suspected infections [WHO 1]. That is a fourfold increase in deaths, and a similar increase in infections.

At this uncontrolled rate alone, the number of deaths in December 2014 will be 20,000 people, and the number of infected people 350000 (and these are far from science-based epidemiological calculations))

This is no longer an outbreak or even an epidemic. With deaths and infections in 7 countries (Sierra Leon, Liberia, Guinea, Senegal, Nigeria, Spain and the US), this is already a pandemic.


A panel of speakers, back from the field in Sierra Leon and Liberia, reported the following, extracted from my notes. The panel included: Dr. P. Farmer (Partners in Health; Brigham and Harvard U.), Dr. Raj Panjabi ( in Liberia, Brigham and Harvard U.), Dr. Dan Kelly ( non Profit in Sierra Leone and UCSF), Ambassador Dr. Eric. O. Goosby (UCSF, and US Global Fund HIV/TB/Malaria) and interviewer Roy Eisenhardt (Interviewer for City Arts and Lectures and the Commonwealth Club):

- 10 years of civil war in Liberia left the country with no infrastructure for public health, and just  41 physicians, 4 of whom died this year in the Ebola epidemic. This amounts to 8 physicians for a city like San Francisco.

- The first case of Ebola was reported in February 2014 when it had already crossed borders from Liberia to Nigeria.

- The estimated toll is 1.4 million by January 2015 if there is no control. Figures are based on known cases, multiplied by 2.5 for all the unknown cases. The ability to find the cases, to treat in isolation, and to take appropriate measures to sanitize, will determine the capacity to control the spread** But finding the sick is contingent upon restoring hope in the medical response, which so far offers no cure rate. And protection measures are inadequate because not enough is known about how the virus spreads from human to human or even from objects contaminated by humans (such as clothes or taxi seats…).

- Stopping the Ebola pandemic implies setting up a long term healthcare system in addition to the ER response with US Troops and 17 MASH units. A long term healthcare system able to prevent any future epidemics or outbreaks.

- Setting up a healthcare system in low income, deprived and underserved places like Sierra Leone, Liberia and Guinea, for example, subsumes having: 1 community worker per village, supervised by 1 nurse at a local dispensary, in communication with a regional hospital or healthcare center, with capacity for transportation of patients with ambulances or vehicles, or planes etc.. This is a model system set up in Haiti that works for low income settings. The system has to involve/mobilize the country in their own destiny. With sufficient funds the system also should have its own teaching hospitals to train local medical personnel. This is now the case in Haiti, and Haiti is sending many volunteer healthcare workers to West Africa. (Cheers to Haiti!)

- Most importantly, the medical response has to restore hope, as it is currently unable to offer care. So the population refuses to go to the ER health centers or isolation wards to die.

- Major players are the UN, WHO and CDCs, already on location.

- The bottom line, however, is that the medical response has to deliver a cure rate, instead of a 90% death rate. This is possible according to Dr. P. Farmer. The virus is not invincible. Care cannot only be palliative. It has to be curative too.

Sorry the news is not any better… Indeed there are not even any IV supplies or beds out there… never mind patented ....
But perhaps there is hope is airlifting everyone who is still healthy to safety, to stop the spread, reduce the burden of care on site.  ... I have two spare rooms in my house and I would truly welcome a family from Liberia or Sierra Leone… before the worse scenarios play out, and until they can return to their beloved country. 

Farmer, P. Dr. Partners in Health
Kelly,  D. Dr. Well Body Alliance
Panjabi, R. Dr. Last Mile Health
WHO1 WHO: Ebola response roadmap situation report – Oct 15, 2014.

No comments: